A Meta‐Analysis of the Efficacy of Ultrasound‐Guided Nasojejunal Tube Placement

BACKGROUND: Critically ill patients are prone to enteral nutrition interruptions during nutritional support, which are primarily due to gastroparesis and subsequent delayed gastric emptying and may hinder clinical recovery. Robust evidence supports the adoption of post-pyloric feeding in this population, with nasojejunal tube placement established as the gold-standard modality for achieving reliable transpyloric access while reducing aspiration risks. AIM: To evaluate the efficacy of ultrasound-guided nasojejunal tube placement in critically ill patients through a systematic review and meta-analysis. STUDY DESIGN: The PubMed, Embase, Web of Science, CINAHL, Cochrane Library, China National Knowledge Infrastructure, Wanfang and Weepu databases were searched for relevant studies from inception to January 2025. Randomised controlled trials (RCTs) that examined the efficacy of ultrasound-guided nasojejunal tube placement in critically ill patients were included. The risk of bias in the included RCTs was assessed using the Cochrane risk of bias tool. Meta-analysis was performed using RevMan 5.4 software. RESULTS: Fifteen studies involving 1164 patients (intervention group: 566; control group: 598) were included, with overall moderate-to-high methodological quality. The meta-analysis demonstrated that ultrasound guidance significantly improved procedural success rates (odds ratio [OR] = 0.21, 95% confidence interval [CI]: 0.15-0.30, p < 0.00001) and positioning accuracy (OR = 0.23, 95% CI: 0.12-0.43, p < 0.00001) compared with blind insertion. Additionally, ultrasound guidance reduced complications, including tube dislodgement (OR = 4.92, 95% CI: 2.26-10.69, p < 0.0001), nasal mucosal bleeding (OR = 3.72, 95% CI: 1.64-8.42, p = 0.002) and arrhythmia (OR = 5.73, 95% CI: 1.40-23.56, p = 0.02). Procedure duration was significantly shorter in the ultrasound group (mean difference [MD] = -18.36 min, 95% CI: -32.42 to -4.30, p < 0.00001). Funnel plot analysis indicated minimal publication bias for success rate outcomes. CONCLUSIONS: Ultrasound-guided nasojejunal tube placement significantly enhances procedural success and anatomical accuracy, reduces complications and optimises operational efficiency. RELEVANCE TO CLINICAL PRACTICE: By leveraging real-time anatomical visualisation, ultrasound technology empowers critical care nurses to enhance procedural success rates and decrease complications during tube placement, particularly in high-risk populations. Standardised training programs integrating ultrasound protocols are recommended to advance evidence-based nursing practice in enteral nutrition management.